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Terminology Heart Failure: The inability of the heart to maintain an output adequate to maintain the metabolic demands of the body. Pulmonary Edema: An abnormal accumulation of fluid in the lungs. CHF with Acute Pulmonary Edema: Pulmonary Edema due to Heart Failure (Cardiogenic Pulmonary Edema)

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tissue CO 2 O2O2 RV LA The Heart is Two Pumps in Series

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Like any pump: The heart generates pressure to deliver blood to the body Therefore it also must…

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Not useful in acute CHF Not useful in acute CHF Decrease HR and output, worsening failure Decrease HR and output, worsening failure May cause/worsen bronchoconstriction May cause/worsen bronchoconstriction However they are used in stable, compensated failure so they may be on a pt’s med list However they are used in stable, compensated failure so they may be on a pt’s med list Pharmacological Treatment: Beta Blockers (Lopressor)???

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CPAP increases the pressure gradient 7.5cm H 2 O CPAP increases the partial pressure of the alveolar air by approximately 1%. This increase in partial pressure ‘forces’ more oxygen into the blood. Even this comparatively small change is enough to make a clinical difference.

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In Summary 1.Heart failure is the result of an acute event (MI, AF) or chronic decompensation 2.Pulmonary edema frequently results from cardiac failure but may also result from other disease processes (ARDS) or direct insult 3.Correct diagnosis is crucial and depends on good history and exam 4.Therapy is both pharmacological and ventilatory support